The Four Ds of Negligence

The Four Ds of Negligence


negligenceThe medical profession is a rewarding one, but full of opportunities to inadvertently run afoul of rules and regulations. Most patients are sincere.

They simply want to get better or see an end to their pain, but there exists a pool of unscrupulous clients who are vigilant in their search for a reason to sue a medical provider for a breach in one of the four Ds of negligence.

The four Ds encompass duty, dereliction, direct cause and damage. The majority of healthcare practice management providers won’t experience the harm to their reputation, clientele and clinic that result from a lawsuit, but medical professionals should be aware that they can be held liable vicariously through the actions of their staff.

To avoid the four Ds of negligence, it’s essential that everyone is conversant in the proper procedures. To be guilty of negligence, a disgruntled patient must prove that the practitioner took action, or failed to, that was ultimately detrimental to the client.

Clinicians should be wary of patients that come into the office requesting specific medications, tests and treatments.

1. Where Duty Begins and Ends

The first of the four Ds refers to duty. Clinicians have a duty to their patients to provide the most accurate diagnosis and care, utilizing their extensive education and experience. Healthcare workers have a duty to inform patients of potential problems they observe upon examination in the clinical setting. They’re under no obligation to provide medical information about any condition they notice in connection with strangers and casual acquaintances, which is a part of negligence.

2. Dereliction of Duty

Dereliction is the second of the four Ds of negligence and refers to actions that a healthcare provider may fail to take. If a medical professional observes a skin condition that could be cancer but neglects to inform the client, it’s a breach of duty.

3. Making a Bad Situation Worse – the Direct Cause

Direct cause is the third element of the four Ds. In this type of negligence, the onus is on the client to prove that the healthcare provider knew about a potential risk, didn’t inform the patient, and the client was injured as a result.

4. Collecting Damages from Clinicians

Rounding out the four Ds of negligence is damages patients can collect in a lawsuit. Damages are the financial compensation clients can collect and includes lost wages, medical expenses and mental duress.

Vicarious and Collateral Liability

Practice owners can be held liable for staff members who make mistakes, don’t follow proper procedures or overstep the boundaries of their responsibilities.

negligence of practice

That includes defamation of character, slander and making libelous statements. It also encompasses invasion of privacy, sharing records without informed consent, violating patient care standards, and malfeasance.

Medical practitioners must work within established laws and parameters when treating patients and ensure staff members are cognizant of what constitutes a breach of the four Ds of negligence.

Staff must be trained in potentially litigious situations for themselves, the practice and the consequences. Education, an understanding of procedures and identifying clients that may come equipped with a lawsuit mentality will help anyone in the medical profession avoid the four Ds.

Physical Therapy Marketing: Limiting Exposure to Bad Payers

Physical Therapy Marketing: Limiting Exposure to Bad Payers





Call Around to Other Healthcare Service Providers





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Physical Therapy Management for Physical Therapy Practices

Physical Therapy Management for Physical Therapy Practices

Manual physical therapy documentation can be time consuming. The trend has been for physical therapists to focus on the admin side instead of providing quality care to patients.

Nitin Chhoda says that it’s about time to use physical therapy software so that practitioners can maximize their time treating patients and increase productivity.

physical therapy managementFor most private practices especially physical therapists who see patients two to three times a week, managing physical therapy billing, dealing with medical billing and coding can be a challenge.

Having a Physical Therapy Software

With physical therapy management software, you can simplify the business side and spend more time doing what you really love, which is working with patients.

You probably are accustomed to using paper records. Perhaps you believe that there is a price barrier to adopting an electronic medical records keeping solution. But the truth is: using physical therapy management software will actually save you money.

Lets ignore the cost of office supplies for a second. Paper records take up lots and lots of space. With that much paperwork, pulling up the information on any given client is a slow and tedious process.

Even if you have a small practice, physical therapy management software can drastically cut back on the time it takes you to locate a patient file and make updates to it.  You can also access the records from anywhere, meaning that you can look up a record when not in the office without bothering whoever you have tasked to maintain your records.

Everything is Digitized

Digital records are also more likely to be accurate and read accurately, since you no longer have to rely on handwritten notes.  Being able to read the records means better care for patients. That is a great physical therapy management plan.

Physical therapy management systems can even include full digital check-in for the patient, logging when they arrive and leave.  This can be done from any computer or iPad, meaning that you can use the physical therapy management system for house calls, too.

Simply by pulling up an online or on-the-computer record, you have quick access to the history and details of any patient you are about to see.  Paperless physical therapy management is elegant and straight-forward.

Solid physical therapy management and scheduling software even simplifies the more complicated aspects of running a physical therapy firm, like managing no-shows and cancellations, and filing paperwork with other offices, insurance companies, and healthcare services.

Proper physical therapy management software makes it easy to delete a cancelled appointment, file Medicare updates for patients, and never get rejected for claims because of technicalities. Physical therapy management systems streamline your business processes and help you to care for more patients, more efficiently. A program that saves you time will save you money.

physical therapy management practiceIntegrated Billing

Perhaps the most compelling aspect of a physical therapy management system is the integration of billing tools.

High quality systems offer a complete physical therapy billing tool that is built into the management tools, so that no matter what you need it is right at your fingertips.

You can include a suite of analysis tools to help you manage payment better. You can figure out how quickly your average patient pays their bills, for example. These tools are critical to helping you run your business as smoothly and as financially responsible as possible.

If you have a physical therapy practice, you need an electronic medical record system. If you start now you can get everything set for the 2014 HITECH Act deadlines. Computers and the Internet have revolutionized how business is done.  Embrace that fact and let it make your practice better.  Have the best physical therapy management plan.

Electronic Health Record Differentiated With EMR

Electronic Health Record Differentiated With EMR

Nitin Chhoda describes the difference between electronic health record and electronic medical record. He gives examples on how these two terms are intertwined, and how they relate to the whole process of physical therapy practice.

electronic health recordElectronic health record or EHR sounds like it might be the same thing as an electronic medical record. However, these two terms should be used differently, in different settings.

While an EMR is a focused digital record that is only used by a single medical clinic, an electronic health record (EHR) is a digital record that is produced so it can be shared between two clinics.

For example, if a patient is admitted to the emergency room with injuries sustained from a car accident, an electronic medical record is started by the hospital.

Until the hospital discharges the patient, they will continue to update the record with diagnoses made, procedures conducted, and medications that have been given to the patient. Electronic health record implementation is still not present at this time.

Let’s say that the major injury sustained by the patient is a broken leg. When the patient is discharged, they will still be in a cast and will not be able to walk until the broken bones have healed. But once they have healed, it’s time for physical therapy.


When the hospital or clinician who has been treating the patient up until this point decides to prescribe physical therapy, they will produce and send an electronic health record to the physical therapist’s clinic.

EHR or electronic health record is a form of communication between medical professionals that summarize the information in a medical record and ensure that the new clinic has all the critical information about each referred patient.

Of course, electronic health record is not entirely mandatory and even transferring patient information from one clinic to another is not required. If the patient did not go to physical therapy right away, but then had trouble reducing pain and limping due to weakness after their injury, they could go to a physical therapist without bringing their official medical history with them.

A patient can request a personal health record (PHR), which is the term for an electronic health record handled by the patient. Or, the patient can have an EHR sent from their previous clinician to the new physical therapist. If they cannot do neither of these things, they can always attempt to describe their injuries to the physical therapist.

electronic health record differentiatedWhile an electronic health record is a useful technological advance which allows for rapid and legible transfer of information, not all medical clinics prefer the electronic system.

Electronic Health Record as a Long-Term

In some ways, the benefits of sharing electronic health record are more long term. In a patient-by-patient situation, clinicians may find it much easier to communicate electronically.

But the broader implications have to do with aggregate data. If clinicians can readily share statistics on the success of certain treatments for particular diseases, they can make more educated and informed decisions when making new treatment plans.

For now, most people who are used to using email and communicating quickly and efficiently, electronic health record seems to be the smartest way to cooperate with other medical clinics. In the future, they may transform the way that clinicians make the most of all available information.

Electronic Medical Records Adoption Checklist

Electronic Medical Records Adoption Checklist

Electronic medical records help simplify physical therapy documentation and billing, and serve to ease the life of the private practice owner.

Before you make a transition, Nitin Chhoda provides a checklist and series of questions to identify the system to use, and how to maximize its effectiveness for your practice.

electronic medical records checklistWhen thinking about adopting an electronic medical records system, there are many things to consider.

The 4 Ws are: Who, What, Why, and When.

Who will come up with a plan for implementation, hold meetings to get buy-in from all staff, and make sure that there is support for everyone using the new system?

What type of software will you select and which brand is best for your practice? Why will your practice benefit from electronic medical records? And when will implementation be completed?

Who Helps Make the Transition Smooth?

The first thing to decide is who will be responsible for defining goals and identifying the requirements of your electronic medical records system? Determining the best implementation plan will probably require a project manager, who will be responsible for the nuts and bolts.

The project manager should work with a clinician or other practitioner who can ensure that the decisions being made will actually benefit the people who will be working with the electronic medical records new program.

For a small practice this may be one and the same person, but it is more likely that a committee or team will be able to accomplish things more smoothly. Because everyone on this team probably has other responsibilities, each will only be able to dedicate a little bit of time. By spreading out the job of getting buy-in and engaging all staff in the electronic medical records process, everyone benefits.

Why Make the Switch?

Answering this question is critical to adopting the right electronic medical records program. Are you hoping that the clinic will be better able to re-schedule after cancellations? Are you interested in making everyone more efficient when it comes to accessing electronic medical records? And do you want reporting options because you want to know where the inefficiencies in your practice can be found?

By answering these types of questions, you will be able to come up with a list of requirements for the electronic medical records program you finally select. This will aid greatly in answering the next question.

What Program Do We Choose?

The project manager will be responsible for determining what electronic medical records program will be the best program, but there are many variables that will help him or her make that determination.

They must consider how the program will be used, on what platforms, and whether or not different programs offer the things your practice needs.

When Do We Finally Switch?

The timing of your switch may change, but by giving yourself some deadlines you can ensure that goals are met on a schedule.

electronic medical records adoptionSwitching over should be relatively smooth, and even though many people are reluctant to learn the new electronic medical records system, you will find that once they get used to it, they will be happier.

Becoming a more efficient staff member and seeing your clinic work more smoothly is encouraging and exciting. Having the control and power to measure your efficiency can really change the way you do business.

Electronic medical records training and adoption can be a very exciting process, and the more you plan and prepare, the smoother the transition will happen.

EMR Adoption Priorities Checklist for Office Managers

EMR Adoption Priorities Checklist for Office Managers

The responsibilities of an office manager in a physical therapy practice are significant. In order to function effectively as a manager, EMR technology plays an important role. Nitin Chhoda outlines the goals and skills necessary to improve efficiency as an office manager.

EMR adoption prioritiesThe job of the office manager in the electronic medical records adoption process requires a holistic approach and the willingness to do a lot of negotiating.

At first, there will be resistance to any new idea, especially if it requires that everyone change their habits.

We get set in our ways, and that is only human. But we are also very good at learning new tricks and getting set in new ways if we have the right attitude.

It is the office manager’s job to help foster a positive attitude. Of course, the office manager must also seriously dedicate him- or herself to the technicalities of implementing a new EMR system.

This will include a resource audit to determine what hardware you have and need, as well as a list of requirements for the new system. Below is one path that office managers can take through the process of EMR adoption.

Goals, Enthusiasm, and Skills for EMR Adoption

  • First of all, determine what your goals are. These will include individual goals of clinicians or staff as well as business goals for improving efficiency and reporting. These goals should be prioritized and they should be reasonable. In other words, you should be able to measure your success and goals should be achievable.

  • Once you have a set of goals, you can start to look for EMR solutions that can and will help you achieve those goals. EMR and EHR systems can vary depending on the designers, programmers, and goals of the system. Finding the system that will work for you will be one of the most important decisions you make.
  • The next step will require that you can think through the changes to come. What will the clinic need to change in order to adopt an EMR solution?

If you want to achieve certain goals, some staff may have to sacrifice comfort temporarily. But if you can see those changes coming, it will be easier to prepare for them.

  • And being able to see what is coming will help you to get the rest of the clinic on board. Building some enthusiasm and managing the expectations of your staff in EMR software adoption process will be critical to making it smooth. Everyone who will be affected should be briefed, asked for feedback, and told what they can expect. The end result should be commitments from all involved that they are ready and willing to make the switch.
  • There will then be a period when you must assess the skills necessary for EMR adoption and efficient use. The skills needed may not align with the skills of current staff, so training may need to be organized.

Resources and Planning

electronic medical records adoption checklistEMR adoption might require an upgrade to the current equipment. If so, you should identify those upgrades now and take care of those changes before implementation.

But once you understand the goals, skills, and resources available and needed for EMR adoption, you will be ready to come up with a plan.

Training, switching over, and implementation will take some time, but if you make a plan, you can follow it to completion.